It's no secret that the C-section rate is rising. Between 1996 and 2007, the rate jumped from 21 percent to 32 percent of all births. What is surprising, however, is that the C-section rate is that high for first-time mothers, according to a recent study published in the American Journal of Obstetrics & Gynecology. One in every three new moms has a cesarean, researchers reported Monday. Concerned about the surgery's costs and its health risks, such as excessive bleeding and infection, public health experts are now trying to bring those rates down.
The C-section rate should be more like 20 percent, as it was in the '90s, says Robert Barbieri, chief of obstetrics and gynecology at Brigham and Women's Hospital in Boston. Much higher than that, he says, suggests that the surgeries are being performed without medical need.
"Most obstetricians would like babies to be born vaginally," says Sebastian Faro, vice-chair of the obstetrics, gynecology, and reproductive sciences department at the University of Texas Health Science Center at Houston, but parents don't necessarily agree. "Have I ever done an elective C-section at the patient's request? The answer is yes," says Faro, who has also refused such requests. He talks to patients about the risks of the surgery and tries to persuade them to attempt a natural birth.
Many C-sections are necessary, to minimize the danger from complications such as placenta previa (when the placenta blocks the opening of the cervix) or a baby in breech position. Surgery may also be warranted if labor fails to progress, which can put the fetus in distress. But C-sections are major operations, says Faro. Aside from the additional risk, women who have them also face a lengthier hospital stay while they recover.
So what can pregnant women do to prevent an unnecessary C-section? Wait as long as possible until natural labor begins, says Barbieri—at least until 39 weeks of pregnancy. In the study mentioned above, the government researchers found that women who were induced had nearly twice the rate of C-sections as those who went into labor on their own. Inducing is more likely to lead to C-section in first-time moms, he says.
Women who have had a C-section should talk to their doctors about having a vaginal birth the next time, says Barbieri. Vaginal births after cesareans, or VBACs, fell out of fashion in the '90s after research suggested the practice raised the risk of uterine rupture, but now doctors are being encouraged to perform them again in light of new findings that rupture risk is slight and repeat C-sections are not risk-free. Guidelines released in July by the American College of Obstetricians and Gynecologists call VBACs safe for most women and urge doctors and hospitals to begin offering them again. Still, women should check to see if their hospital allows VBACs. Not all of them do.